tbuckley/cabot-search huggingface dataset:
Abstract 15895: Causes and Predictors of 30-Day Readmission After Implantable Cardioverter/Defibrillator Insertion in Heart Failure Patients: Insight From the National Readmissions Database
Authors: Mouna Kodali, Ramtej Atluri, Sreeram Yalamanchili, Ufuk Vardar, Sami Shoura, Sujitha Velagapudi
Journal: Circulation (2022)

Introduction: Implantable Cardioverter/Defibrillator (ICD) insertion in heart failure (HF) patients with ejection fraction below 30% and at least 40 days post-infarction is rapidly becoming commonplace. Given the high prevalence of ICD insertions in HF patients with reduced ejection fraction (HFrEF) we aimed to analyze the rates and causes of readmissions in this specific population. Methods: We utilized the National Readmission Database from 2018 to identify hospitalized adults with HF who underwent ICD insertion. We included those who were readmitted within 30 days after the index admission. We excluded elective and traumatic admissions. A multivariate cox regression model was used to identify independent predictors of readmission. Results: During the study period, 283,539 hospitalized patients with HF who underwent ICD insertion were discharged alive. Within 30-days from discharge, 46,537 (16.4%) were readmitted. The top three causes of readmission were heart failure (35.2%), sepsis (5.26%), and ventricular tachycardia (4%). Readmitted patients were more likely to be discharged to nursing facility (45% vs 38%; p&lt;0.001), had higher rates of Medicare/Medicaid (89.2% vs 78.7%; p&lt;0.001) and annual income &lt; $44,000 (35.7% vs 33%; p&lt;0.001). In-hospital mortality (5.6% vs 3.4%; p&lt;0.001) was higher during readmission. Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions. Conclusions: We identified social and clinical predictors of readmission after ICD insertion in those with HF such as household income, discharge to a nursing home, renal/lung disease, and intubation during their index admission. Healthcare systems should use this data to target modifiable factors to prevent readmissions as this can help ease the burden placed on the resources of the American healthcare system and improve clinical outcomes for patients.
Abstract 254: The Epidemiology Of Paediatric Out-of-hospital Cardiac Arrest In Australia And New Zealand
Authors: Janet Bray, Stuart Howell, Jason Acworth, Judith C Finn, Stephen Ball, Karen L Smith, Natalie Heriot, Emma Bosley, Steven Faddy, Tan Doan, Andrew Thomas, Alex Wilson, Bridget Dicker, Andy SWAIN, Melanie Thorrowgood, Sam Perillo
Journal: Circulation (2022)

Introduction: Adult OHCA has been well described in Australasian studies, however little is known about paediatric OHCA in our region. This study describes the epidemiology of paediatric OHCA across Australia and New Zealand. Method: Data for paediatric OHCA were extracted from the Aus-ROC Epistry for the period 2017-2019. The Aus-ROC Epistry captures data nationwide across Australia and New Zealand covering a target population of roughly 30 million people. Paediatric OHCA was defined as an OHCA occurring in persons aged less than 18 years and classified as &lt; 1 year, 1-5 years, 6-11 years and 12-17 years. Results: There were 2008 paediatric OHCA during the study: 701 aged below 1 year, 363 aged 1-5 years, 217 aged 6-11 years and 728 aged 12-17 years. There was considerable variation across age groups with respect to core arrest features, including home arrests (range: 61% to 89%), witnessed arrests (range: 22%-51%), arrests of medical aetiologies (range: 33%-95%) and arrests with a shockable initial rhythm (range: 1% to 10%). Bystander CPR in non-EMS witnessed cases was 63% and ranged from 58% in 12-17 year-olds to 73% in 1-5 year-olds.Resuscitation was attempted in 1319 cases (65.7%): 490 aged &lt;1 year, 267 aged 1-5 years, 154 aged 6-11 years and 408 aged 12-17 years. Resuscitation rates varied across age groups ranging from 56% amongst 12-17 year-olds to 73% amongst 1-5 year-olds. In EMS treated cases, 28% had a return of spontaneous circulation (ROSC) in the prehospital setting (range: 19% to 38%) and 24% had ROSC on hospital arrival (range: 17%-33%). Rates of survival to hospital discharge/30 days was 6.8% overall, and ranged from 6.1% in infants (&lt;1 year) to 11.8% in children aged 6-11 years. Conclusion: There is considerable heterogeneity in paediatric OHCA, characterised by differences on key measures across age groups.
Abstract 225: Late Awakening In Comatose Survivors Of Out-of-hospital Cardiac Arrest
Authors: Spela Tadel-Kocjancic, Anja Jazbec, Marko Noc
Journal: Circulation (2022)

Background: Despite advanced neuroprognostication using neuron-specific enolase, electroencephalogram and brain imaging, prediction of neurological outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA) remain challenging and early discontinuation of postresuscitation treatment may be harmful for patients with delayed awakening. Hypothesis: Significant proportion of comatose survivors of OHCA may regain consciousness only after discharge from intensive care unit (ICU). Methods: Consecutive comatose survivors of OHCA admitted to our ICU between January 1, 2003 and December 31, 2021 were investigated. Cerebral performance category (CPC) was used for evaluation of neurological recovery. CPC 1 indicated complete recovery, CPC 2 mild neurological impairment, CPC 3 severe neurological impairment and CPC 4 vegetative state. Results: A total of 1098 patients (63 + 14 years, 79% (864 of 1098) men) were enrolled. OHCA was witnessed in 88% (966 of 1098), basic life support was performed in 57% 630 of 1098), delay to emergency team arrival was 7.5 + 5.3 minutes and initial shockable rhythm was present in 77%. (851 of 1098). Reestablishment of spontaneous circulation (ROSC) was obtained after 12.9 + 11.8 minutes of advanced life support. Coronary angiography was performed in 74% (822 of 1098) and percutaneous coronary intervention in 52% (567 of 1098). Mechanical circulatory support was used in 16% (175 of 1098) and hypothermia (32-34 C) in 85% (940 of 1098). Among 740 patients who survived to ICU discharge on day 7 (median), 272 patients (36.8%) of patients remained in CPC 3-4 ( Figure). Among these 272 patients, CPC 1-2 at hospital discharge was documented in 19.9%. (54 patients). Conclusion: Almost 20% of comatose survivors of OHCA without neurological recovery at ICU discharge may ultimately regain consciousness. This argues against premature withdrawal of care in step down units and normal wards.
Questioning the purpose of annual follow-up spirometry for all patients with COPD
Authors: Jehangir Khan, Cormac McCarthy, Alessandro N. Franciosi
Journal: European Respiratory Journal (2023)

<b>GOLD guidelines recommend yearly spirometry for all patients living with COPD. Is this recommendation too broad, and what actionable findings can serial spirometry provide?</b>https://bit.ly/3J82sjs
Abstract 200: Left-ventricular Outflow Compression During Cardiopulmonary Resuscitation Is Associated With Lower Return Of Spontaneous Circulation In Out-of-hospital Cardiac Arrest
Authors: Felipe Teran, Nathaniel Sands, Trenton Wray, Wendy A Hanna, Erik Kraai, Jenna White, Ranjani Venkataramani, John E Hipskind, Jonathan Nogueira, Michelle Clinton, Michael Jones, Daniella Rodriguez, Peiman Nazerian, Eleonora de Villa, Justine Lessard, William Bédard Michel, Chantal Lanthier, Lawrence Haines, Leily Naraghi, Harpriya Singh, Antonios Likourezos, Michael Y Woo, Paul Pageau, Rajiv Thavanathan, Michael Secko, Daniel Singer, Brian M Buchanan, Nadia Baig, Korbin Haycock, Ramiz Fargo, Lauren D Sutherland, Harry Wanar, James Coleman, Zan M Jafry, John M Joyce, Aaron Hittson, Lindsay Taylor, Michael Vitto, Stephanie DeMasi, Katharine M Burns, Pedro D Salinas, Matthew D Tyler, Frank Myslik, Robert Arntfield, Branka Vujcic, Clark Owyang, Tomislav Jelic, Benjamin Abella
Journal: Circulation (2022)

Introduction: Transesophageal echocardiography (TEE) has been proposed as a tool ideally suited for imaging patients during cardiac arrest (CA) resuscitation, allowing for the evaluation of the area of maximal compression (AMC) during CPR. Previous work has shown that compression of the left-ventricular outflow tract (LVOT) or the aortic root during CPR (AMC-LVOT/Ao) occurs in over 50% of patients; animal trials and small single-center retrospective clinical study have linked this finding to lower rates of ROSC. We aimed to prospectively investigate the AMC and its association with ROSC. We hypothesized that patients who have AMC-LVOT/Ao have lower likelihood of ROSC. Methods: A prospective, observational, multicenter cohort study involving patients with out-of-hospital CA (OHCA) in whom TEE was performed during CPR. The study aimed to compare patients with AMC over the LV (AMC-LV) vs AMC-LVOT/Ao and was conducted through a collaborative research network involving 16 hospitals (NCT04972526). Data was collected on clinical and TEE characteristics and findings. Primary outcome was ROSC. We performed univariate analysis followed by multivariate regression model evaluating variables known to impact resuscitation outcomes. Results: Eighty-four patients were included in the analysis. Mean age 62 (46-72), 28% female, 71% had witnessed arrest, 60% had bystander CPR, 47% had mechanical CPR. Overall 26 patients (32%) had ROSC. Initial AMC during CPR was determined in 55/84 (65%) patients, of whom 33 (60%) had AMC-LV, 18 (33%) had AMC-LVOT/Ao, and 4 (7%) had other locations. There was no significant difference in AMC when analyzed by demographic characteristics, height, weight or between patients who received manual vs mechanical CPR. In multivariate regression controlling for age, race, gender, initial rhythm of arrest, level of TEE operator, doses of epinephrine, now-flow time, and total time of arrest, AMC-LVOT/Ao was significantly associated with lower ROSC probability (OR 0.06, 95% CI 0.01-0.4; p=0.009). Conclusion: In this multicenter, prospective study of patients with OHCA, TEE-guided resuscitation showed a strong association between the AMC and ROSC.
Abstract 15273: Impact of Lipid Lowering Therapy on Progenitor Endothelial Cell Phenotype and Function in Coronary Artery Disease
Authors: Francisco Jimenez-Trinidad, Joaquim Bobi, Luis G. Ortega-Paz, Juan J Rodr?guez Arias, Merce Roque, Manel Sabate, Salvatore Brugaletta, Ana Paula V Dantas
Journal: Circulation (2022)

Introduction: Early revascularization of infarcted zone is crucial to improve patient′s outcomes. Despite their primary actions, major lipid-lowering drugs may also reduce cardiovascular events by pleiotropic mechanisms. Hypothesis: Conventional (statin) and novel lipid-lowering therapies [(PSCK9-inhibitor (PCSK9i) and eicosatetraenoic acid (EPA)] can improve endothelial progenitor cells (EPC) phenotype and favor neovascularization. Methods: EPC were isolated from peripheral blood of patients with acute coronary syndrome (n=62) who were statin-naïve (n=34) or chronic statin treatment (n=28) at time of inclusion. A set of statin-naïve EPC and mature endothelial cells (HUVEC) were treated in vitro with statin (20nM), PCSKi (1μM) and EPA (3μM). EPC phenotype was determined as EPC colony number and time of appearance, proliferative rate, and ability to form capillary-like structures. Serum PCSK9 and markers of angiogenesis and endothelial function were determined by multiplexed protein assay. Results: Frequency of EPC appearance was higher in samples of statin group (78%) compared to naïve group (66%) (Fig A). They also appeared much earlier (Fig B), in greater quantity (4.7 vs 2.1 colony, p = 0.0009) and had higher proliferative rate than EPCs of naïve group. Besides they had increased potential of tube formation and shaped more branched vessel-like structures (Fig C). No differences in serum levels of biomarkers were found. In vitro treatment of EPC with statin, PCSK9i and EPA did not modify colonies behavior (Fig D). PCSK9 levels showed negative correlation with EPC proliferation (r -0.4150, p=0.004), and PCSK9i treatment increased angiogenic potential of HUVEC (Fig E). Conclusions: Statin and PCSK9i have pleiotropic effects on EPC, boosting their potential to form endothelial cells colonies and to induce angiogenesis. These effects could contribute to the progression and outcomes of coronary artery disease. Funding: ISCIII - FEDER-ERDF (PI19/00264)
Abstract 218: Sinus Rhythm Predicts Return Of Spontaneous Circulation In Pulseless Electrical Activity
Authors: Karianne Tanem Mardal, Eirik Skogvoll, Jan P Loennechen, Anders Norvik
Journal: Circulation (2022)

Background: Pulseless electrical activity (PEA) is a heterogeneous clinical state and increasingly observed during resuscitation from cardiac arrest. The aim of this study was to investigate whether the presence or emergence of sinus rhythm in patients with PEA influenced the likelihood of return of spontaneous circulation (ROSC). Methods: Single-lead ECGs were registered during resuscitation from in-hospital cardiac arrests (IHCAs) with PEA. We analyzed evidence of atrial/sinus rhythm as the presence or emergence of P-waves; expressed along the resuscitation timeline as a prevalence (between 0 and 1) during the preceding minute. This information was entered along with QRS-duration as a continuous, time-dependent covariate in an exponential multistate time-to-event model. We employed the software R version 4.1 for the statistical analyses. Results: 99 episodes of CA from 90 patients were analyzed. We identified 189 segments of PEA without sinus rhythm and 52 segments with sinus rhythm. Almost none had sinus rhythm initially; usually it emerged as a response to resuscitation. Among segments with sinus rhythm, 22 transitioned to ROSC (42 %) while 55 without sinus rhythm transitioned to ROSC (29 %).According to the exponential model, a one-unit increase in the prevalence of sinus rhythm increased the chance of developing ROSC by a factor of 2.5 (95% CI 1.33-4.72). Conclusion: The emergence of sinus rhythm during treatment of PEA increases the probability of gaining ROSC. Sinus rhythm seems to be an intermediate stage in the development from PEA to ROSC. Sinus rhythm is easy to identify during cardiac arrest and may serve as a marker of treatment response. Occurrence of PEA with atrial rhythm during CA should encourage continuation of resuscitation. Figure: Left column displays rhythms before PEA with SR and right column displays rhythms following PEA with SR.Green: ROSC. Orange: PEA with sinus rhythm. Yellow: PEA. Red: VT/VF. Grey: ASY. Dark grey: Death.
Abstract 168: Hypoxia On Arrival At The Hospital Among Major Traumatic Brain Injury Patients Who Were Non-Hypoxic In The Field: Support For “Hyper-oxic” Prehospital Treatment?
Authors: Daniel W Spaite, Chengcheng Hu, Bentley J Bobrow, Bruce J Barnhart, Joshua B Gaither, Amber D Rice, Vatsal Chikani, Kurt R Denninghoff, Gail H Bradley, Jeffrey T Howard, Samuel M Keim
Journal: Circulation (2022)

Background: Prehospital and early hospital hypoxia powerfully affect traumatic brain injury (TBI) outcomes. However, the correlations between EMS and hospital O2 saturations are unknown. Using the EPIC Study data (NIH-1R01NS071049; DOD-W81XWH-19-C-0058), we assessed correlations between EMS SpO2 and the risk of major TBI patients arriving at the trauma center (TC) with hypoxia (initial ED SpO2&lt;90%). Methods: Subjects meeting EPIC Study criteria, age ≥10 years, and transported directly to the TC were included. Basic statistics were determined by Kruskal-Wallis, Chi-square or Fisher’s exact test. Adjusted odds (aOR) were assessed using logistic regression, controlling for significant confounders. Results: A total of 10,370 subjects were included. Compared to no hypoxia, aORs for death were: EMS, but no TC hypoxia: 2.1 (1.7-2.6), TC, but no EMS hypoxia: 2.5 (1.7-3.8), both EMS/TC hypoxia: 3.2 (2.1-4.8; p&lt;0.0001). Among the 9,243 cases with no EMS hypoxia, only 242 [2.6% (2.3%-3.0%) were hypoxic at TC arrival, compared to 215 of 1127 cases that had EMS hypoxia [19.1% (16.8%, 21.5%); OR: 8.8 (7.2, 10.7); aOR: 4.6 (3.7, 5.7); p&lt;0.0001]. The Figure shows the odds of arriving hypoxic at the TC, based upon the lowest recorded EMS SpO2 (whether hypoxic or not). Conclusion: As expected, hypoxia upon TC arrival was highly correlated with EMS hypoxia (OR 8.8, aOR 4.6). However, it is remarkable that even a single EMS SpO2 below 100% was associated with 2.4 greater odds of TC hypoxia (&lt;90%). Given our recent findings that the optimal odds of survival occurs in patients whose recorded EMS SpO2s were always 100%, these findings argue against the popular concept of preventing “ hyper -oxia” by titrating O2 to maintain SpO2 in the mid/upper 90s. Our results imply that keeping EMS SpO2 as high as possible prevents subsequent hypoxic episodes (i.e., “pre-oxygenation” for unexpected deterioration) and supports maintaining an SpO2 of 100% during the prehospital interval in major TBI.
Abstract 172: Utility Of Cerebrospinal Fluid Lactate To Predict Neurological Prognosis In Patients With Out Of Hospital Cardiac Arrest Undergoing Target Temperature Management
Authors: Yeonho You, Changshin Kang, Hong Joon Ahn, Jung Soo Park, Won-joon Jeong, Jinhong Min, Yong In
Journal: Circulation (2022)

Utility of cerebrospinal fluid lactate to predict neurological prognosis in patients with out of hospital cardiac arrest undergoing target temperature managementLactate is a predictor of poor neurological prognosis in patients with OHCA undergoing TTM.However, CSF lactate is independent on serum lactate, and has rapid turn around time. Therefore, we investigated the prognostic value of CSF lactate, measured every 2 h for 24 h after ROSC and the incidence of mitochondrial dysfunction (MD) and ischaemia with increased CSF lactate in the groups with good and poor neurological prognosis.This was a prospective observational study conducted from March 2021 to April 2022 (**** IRB 2020-04-051). All patients were monitored with aEEG. Serum and CSF were obtained using a radial arterial and a lumbar catheter. 22 patients were required through sample size calculation. The comparison of lactate between the two groups was evaluated using the generalized estimating equation. The AUROC was used to identify the prognostic values of lactate (Fig. 1, Table 1). Parameters measured immediately, and 24 h after ROSC were not different between the two groups (Table 2). CSF lactate level was higher in the group with poor neurological prognosis, and CSF lactate showed better performance in predicting poor neurological prognosis, even after 6 h post ROSC (Table 3, 4, Fig. 2). Additionally, the neurological prognosis was poor when MD or ischaemia in brain persisted more than 16 h after ROSC (Fig. 3).This study demonstrated that CSF lactate was a valuable tool in predicting poor neurological prognosis, and cases in which MD or ischaemia in the brain persisted more than 16 h after ROSC had poor outcome.
Contents
Authors: B Sangro, P Angeli, A Julia, M Wendon, George Papatheodoridis, E Tsochatzis, Bertoletti Antonio, Tanaka Koichi, A Craig, M Silveira, R Helsley, S.-H Park, H Vekaria, P Sullivan, L Conroy, R Sun, L Romero, J Herrero, C Bons, J King, J Rose, B Meyer, C Schilling, S Kahn, B Jagadisan, A Verma, M Deheragoda, A Deep, T Grammatikopoulos, M Sudhanva, S Bansal, N Hadzic, S Vimalesvaran, N Heaton, A Dhawan, I Montali, C Berti, M Morselli, G Acerbi, V Barili, G Pedrazzi, B Montanini, C Boni, A Alfieri, M Pesci, A Loglio, E Degasperi, M Borghi, R Perbellini, A Penna, D Laccabue, M Rossi, A Vecchi, C Tiezzi, V Reverberi, C Boarini, G Abbati, M Massari, P Lampertico, G Missale, C Ferrari, P Fisicaro, S Caminada, A Mele, L Ferrigno, V Alfonsi, S Crateri, G Iantosca, M Sabato, M Tosti, A Guerrero, L Campo, F Piscaglia, B Scheiner, G Han, F Violi, C.-N Ferreira, L Téllez, T Reiberger, S Basili, J Zamora, A Albillos, B Agarwal, R Cañizares, F Saliba, M Ballester, D Tomescu, D Martin, V Stadlbauer, G Wright, M Sheikh, C Morgan, C Alzola, P Lavin, D Green, R Kumar, S Sacleux, G Schilcher, S Koball, A Tudor, J Minten, G Domenech, J Aragones, K Oettl, M Paar, K Waterstradt, S Bode-Boger, L Ibáñez-Samaniego, A Gander, C Ramos, A Chivu, J Stange, G Lamprecht, M Sanchez, R Mookerjee, A Davenport, N Davies, M Pavesi, F Andreola, J Cordingley, H Schmidt, J Carbonell-Asins, V Arroyo, J Fernandez, S Mitzner, R Jalan, A Lapitz, M Azkargorta, P Milkiewicz, P Olaizola, E Zhuravleva, M Grimsrud, C Schramm, A Arbelaiz, C O'rourke, A Casta, M Milkiewicz, T Pastor, M Vesterhus, R Jimenez-Agüero, M Dill, A Lamarca, J Valle, R Macias, L Izquierdo-Sanchez, Y Castaño, F Caballero-Camino, I Riaño, M Krawczyk, C Ibarra, J Bustamante, L Nova-Camacho, J Falcon-Perez, F Elortza, M Perugorria, J Andersen, L Bujanda, T Karlsen, T Folseraas, P Rodrigues, J Banales, P Burra, F Tacke, V Ratziu, S Zeuzem, J Kellum, M Nadim, D Samuel, R Morikawa, N Nakamoto, T Amiya, P.-S Chu, Y Koda, T Teratani, T Suzuki, Y Kurebayashi, A Ueno, N Taniki, K Miyamoto, A Yamaguchi, S Shiba, T Katayama, K Yoshida, Y Takada, R Ishihara, H Ebinuma, M Sakamoto, T Kanai, S.-T Cheng, J.-L Hu, J.-H Ren, H.-B Yu, S Zhong, V Wong, B Kwan Law, W.-X Chen, H.-M Xu, Z.-Z Zhang, X.-F Cai, Y Hu, W.- L Zhang, Q.-X Long, F Ren, H.-Z Zhou, A.-L Huang, J Chen, J Howell, A Pedrana, S Schroeder, N Scott, L Aufegger, R Atun, R Baptista-Leite, G Hirnschall, E 't Hoen, S Hutchinson, J Lazarus, L Olufunmilayo, R Peck, M Sharma, A Sohn, A Thompson, M Thursz, D Wilson, M Hellard, S.-Y Cai, D Yu, C Soroka, J Wang, J Boyer, D Chand, F Mohr, H Mcmillan, F Tukov, K Montgomery, A Kleyn, S Tauscher-Wisniewski, P Kaufmann, G Kullak-Ublick, T Marjot, A Moon, J Cook, S Abd-Elsalam, C Aloman, M Armstrong, E Pose, E Brenner, T Cargill, M.-A Catana, R Dhanasekaran, A Eshraghian, I García-Juárez, U Gill, P Jones, J Kennedy, A Marshall, C Matthews, G Mells, C Mercer, P Perumalswami, E Avitabile, X Qi, F Su, N Ufere, Y Wong, M.-H Zheng, E Barnes, A Barritt, G Webb
Journal: Journal of Hepatology (2023)
JHEP at a glance (July 2023)
Authors: Robert Helsley, Se-Hyung Park, Hemendra Vekaria, Birgit Schilling, C Kahn, Samir Softic, ↑ Khk-C ↓ Sirt-, Barath Jagadisan, Anita Verma, Maesha Deheragoda, Sunitha Vimalesvaran, Nigel Heaton, Anil Dhawan, Susanna Caminada, Annamaria Mele, Luigina Ferrigno, Giuseppina Iantosca, Marise Sabato, Maria Tosti
Journal: Journal of Hepatology (2023)